Early Resolution of New-Onset Left Bundle Branch Block After Transcatheter Aortic Valve Implantation With the SAPIEN 3 Valve.
Early Resolution of New-Onset Left Bundle Branch Block After Transcatheter Aortic Valve Implantation With the SAPIEN 3 Valve.
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使用 SAPIEN 3 瓣膜经导管主动脉瓣植入后新发左束支传导阻滞的早期解决
DOI：
10.1016/j.amjcard.2021.12.032
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通讯作者：
Puri R.
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作者：
Isogai T;Dykun I;Agrawal A;Shekhar S;Tarakji KG;Wazni OM;Kalra A;Krishnaswamy A;Reed GW;Kapadia SR;Puri R.
新发左束支分支传导阻滞（LBBB）在经导管主动脉瓣植入术（TAVI）后很常见，但可在TAVI后阶段消退。我们试图检查使用SAPIEN 3（S3）瓣膜的TAVI接受者新发LBBB早期消退的发生率、预测因素和结局。在2016年至2019年期间，在我们机构没有预先存在的起搏器或宽QRS波群的1，203名S3-TAVI接受者中，我们确定了143名在TAVI期间发生新发LBBB的患者，并根据TAVI后第二天LBBB的消退或持续性对其进行分类，以比较高度房室传导阻滞（HAVB）和永久性起搏器（PPM）的发生率。与持续性LBBB患者相比，LBBB消退患者（n = 74，52%）更常见于女性，基线和TAVI后QRS持续时间更短，S3尺寸更小，植入深度更浅。多变量逻辑回归模型显示TAVI后QRS持续时间（每增加10 ms，比值比= 0.60 [95%置信区间= 0.44 - 0.82]）和植入深度（每增加1 mm深度，0.77 [0.61 - 0.97]）与LBBB消退可能性较低显著相关。在TAVI后30天内，LBBB消退的患者均未发生HAVB。同时，8例（11.6%）持续LBBB患者发生HAVB。持续性LBBB后的2年PPM率显著高于LBBB消退后（30.3% vs 4.5%，对数秩p <0.001），主要是由于30天PPM率较高（18.8% vs 0.0%）。总之，在S3-TAVI期间发生的新发LBBB中，约有一半在TAVI后第二天消退，无HAVB。相反，由于HAVB风险，新发持续性LBBB可能需要在30天内进行随访和动态监测。
New-onset left bundle branch block (LBBB) is common after transcatheter aortic valve implantation (TAVI) but can resolve in the post-TAVI period. We sought to examine the incidence, predictors, and outcomes of early resolution of new-onset LBBB among TAVI recipients with a SAPIEN 3 (S3) valve. Among 1,203 S3-TAVI recipients without a pre-existing pacemaker or wide QRS complex at our institution between 2016 and 2019, we identified 143 patients who developed new-onset LBBB during TAVI and divided them according to the resolution or persistence of LBBB by the next day post-TAVI to compare high-degree atrioventricular block (HAVB) and permanent pacemaker (PPM) rates. Patients with resolved LBBB (n = 74, 52%), compared with those with persistent LBBB, were more often women and had a shorter QRS duration at baseline and post-TAVI, with a smaller S3 size and a shallower implantation depth. A multivariable logistic regression model demonstrated significant associations of post-TAVI QRS duration (per 10 ms increase, odds ratio = 0.60 [95% confidence interval = 0.44 to 0.82]) and implantation depth (per 1-mm-depth-increase, 0.77 [0.61 to 0.97]) with a lower likelihood of LBBB resolution. No patient with resolved LBBB developed HAVB within 30 days post-TAVI. Meanwhile, 8 patients (11.6%) with persistent LBBB developed HAVB. The 2-year PPM rate was significantly higher after persistent LBBB than after resolved LBBB (30.3% vs 4.5%, log-rank p <0.001), mainly driven by higher 30-day PPM rate (18.8% vs 0.0%). In conclusion, about half of new-onset LBBBs that occurred during S3-TAVI resolved by the next day post-TAVI without HAVB. In contrast, new-onset persistent LBBB may need follow-up with ambulatory monitoring within 30 days because of the HAVB risk.
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